Patient characteristics and short-term outcomes.

BackgroundRobotic pancreatoduodenectomy (RPD) is a newly introduced procedure, which is still evolving and lacks standardization. An objective assessment is essential to investigate the feasibility of RPD. The current study aimed to assess our initial ten cases of RPD based on IDEAL (Idea, Development, Exploration, Assessment, and Long-term study) guidelines.MethodsThis was a prospective phase 2a study following the IDEAL framework. Ten consecutive cases of RPD performed by two surgeons with expertise in open procedures at a single center were assigned to the study. With objective evaluation, each case was classified into four grades according to the achievements of the procedures. Errors observed in the previous case were used to inform the procedure in the next case. The surgical outcomes of the ten cases were reviewed.ResultsThe median total operation time was 634 min (interquartile range [IQR], 594–668) with a median resection time of 363 min (IQR, 323–428) and reconstruction time of 123 min (IQR, 107–131). The achievement of the whole procedure was graded as A, “successful”, in two patients. In two patients, reconstruction was performed with a mini-laparotomy due to extensive pneumoperitoneum, probably caused by insertion of a liver retractor from the xyphoid. Major postoperative complications occurred in two patients. One patient, in whom the jejunal limb was elevated through the Treitz ligament, had a bowel obstruction and needed to undergo re-laparotomy.ConclusionsRPD is feasible when performed by surgeons experienced in open procedures. Specific considerations are needed to safely introduce RPD.背景：机器人胰十二指肠切除术（Robotic Pancreatoduodenectomy, RPD）是一项新兴术式，目前仍处于发展阶段且缺乏标准化流程。客观评估对于探究RPD的临床可行性至关重要。本研究旨在基于IDEAL（构想、开发、探索、评估与长期研究）指南，对本中心开展的首批10例RPD病例进行系统性评估。 方法：本研究为遵循IDEAL框架开展的前瞻性2a期研究。本中心由两名精通开放手术的外科医师完成的连续10例RPD病例被纳入本研究。通过客观评估体系，每例病例依据手术完成质量被划分为四个等级。前一例术中观察到的操作失误将用于指导后续病例的手术优化。本研究对10例病例的手术结局进行了回顾性分析。 结果：手术总时长中位数为634分钟（四分位间距[IQR]：594~668分钟），其中切除操作时长中位数为363分钟（IQR：323~428分钟），消化道重建时长中位数为123分钟（IQR：107~131分钟）。2例患者的整体手术完成质量被评为A级，即"手术成功"。2例患者因广泛气腹（推测由剑突下置入肝脏拉钩所致），采用迷你剖腹术完成消化道重建。2例患者出现术后严重并发症：1例因经屈氏韧带（Treitz韧带）提拉空肠袢发生肠梗阻，需接受再次剖腹手术。 结论：由精通开放手术的外科医师实施RPD具备临床可行性。安全开展该术式需针对性考量相关特殊要点。